Since a trickling of blood indicates a fulness in the whole body, or in
the head, being occasioned either by expression or contraction, and as a
free evacuation would relax them, and diminish the quantity, it may be
proper to evacuate where nature points. With this view, I have ventured,
in cases of quartan epistaxis, to open the vessels in the nostrils with
the reed called typha. We must not be contented with a small evacuation,
but must take away blood in proportion to the strength. Spontaneous
hemorrhages from the nose in fevers, when critical, are not to be
interfered with; but yet, if the flow of blood be immoderate, it ought to
be restrained. In the first place, tight ligatures ought to be applied to
the patient’s extremities, and his head elevated. It would appear that
a ligature to the privy parts, is particularly adapted for restraining
bleeding from the nose. The nostrils ought not to be wiped, nor the part
irritated, so that a clot of blood may be allowed to form. Let the nose
be cooled by a sponge soaked in oxycrate, and the nostril plugged up with
a pledget dipped in some of the astringent applications. The composition
of them, and the rest of the treatment, we will deliver more fully in the
following Book, “on topical affections.”
* * * * *
COMMENTARY. Hippocrates declares that profuse bleeding at the nose
indicates a disposition to convulsions, which venesection is calculated
to remove. (Prædict. i, 21.) Galen, in his Commentary, remarks that the
convulsions are brought on by the unseasonable use of cold applications
to stop the hemorrhage. He strongly recommends bleeding from the arm of
the side from which the blood flows. In another place, he states that
epistaxis in acute fevers is an unfavorable symptom. (In iii, Epidem.
Comment.)
Aëtius mentions that Hippocrates had declared a bleeding from the nose
on the fourth day of a fever to be a very bad symptom. He recommends
encouraging the bleeding by irritating the nostrils with a stalk of
grass. Our author, it will be observed, directs this operation to be
performed until the _typha_, a species of grain several times mentioned
by Theophrastus (Hist. Plant.); by Galen (de Aliment. i, 13); and by
Alexander Trallian (vii, 5.) Sprengel makes it to be a species of secale
or rye; but Stackhouse, the English editor of Theophrastus, is of opinion
that it was the _triticum spelta_, or spelt.
When it is judged proper to restrain the hemorrhage, Avicenna recommends
ligatures to the extremities and cold and styptic applications to the
nose and adjoining parts, (iv, i, 2, 14, and iii, v, 1.) Serapion
agrees with most of the ancient authorities in commending a mixture of
frankincense and aloes, when applied on the down of a hare. He also
directs us to apply a sponge soaked in cold water to the temples and
forehead. (ii, 13.) When bleeding at the nose occurs in a fever, Rhases
forbids us to stop it, unless it prove excessive; in which case, he
directs us to apply a cupping instrument, without scarification, to the
hypochondrium; to tie ligatures about the testicles; to pour cold water
on the head; and to drink cold water. (Divis. 40.)
Considering how full and accurate our author and the others are in
treating of the complications of fever, it is singular that they should
all have passed by a profuse discharge of blood per anum, although it had
been noticed by Hippocrates. In one of his Aphorisms he says: “When, in
cases of fever, there is a quantity of blood discharged, the bowels get
into a loose state.” His commentators Theophilus and Damascius say, in
explanation, that the natural heat of the intestines being wasted by the
discharge of blood, they lose their power of retention. (Ed. Dietz, ii,
401.)